Fall Prevention in Acute Care Hospitals: A Randomized Trial

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Warren Bryan Collins
10 years ago
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Nurse Scientist Program Director Center for Patient Safety Research & Practice

1 Fall Prevention in Acute Care Hospitals: A Randomized Trial Patricia C. Dykes DNSc, RN, FAAN, FACMI Sr. Nurse Scientist Program Director Center for Patient Safety Research & Practice Center for Nursing Excellence Brigham and Women s Hospital Assistant Professor, Harvard Medical School [email protected] March 6, 2013

2 Preliminary Work/Fall TIPS Toolkit Results From the Clinical Trial Lessons Learned/Implications 2

3 Introduction Falls are a leading cause of death and disability ~ 33% of older adults fall each year Hospitalization increases the risk for falls ~ 3% hospitalized patients fall ~ 30% of inpatient falls result in injury Patient falls and injurious falls are employed as national metrics for nursing care quality The incidence of patient falls and related injuries are publicly reported by acute care hospitals. As of October 2008, costs associated with fall-related injuries in hospitals are no longer reimbursable under Medicare

employed as national metrics for nursing care quality The incidence of patient falls and related injuries are publicly reported by

4 Fall Prevention at Partners HealthCare Reducing falls is high priority goal for Partners HealthCare (PHS) : Fall TIPS conducted in 4 PHS hospitals Robert Wood Johnson Foundation funded study Aim: To establish linkages between routine nursing fall risk assessment, structured communication and tailored interventions to prevent falls

Wood Johnson Foundation funded study Aim: To establish linkages between routine

5 Barriers to Fall Prevention Delays in patient report Well, we (PCAs) come in at 7 they (RNs) are giving report to each other. We are on the floor I don t know who has been asleep since 10:30 at night. I don t know his activity level If I don t have this information I have to go over there and then come back to the nurse. Generic signage If we have 35 patients on the floor and shy ten they are all on fall precautions. It s like everybody falls into that category... Lack of individualized (tailored) information When we identify someone at risk for fall, we need to talk more about the intervention that goes along with their risk for fall. Is it cognitive? Physical? A high score might not tell you why the person is at risk. It is a critical piece of information (knowing what to do when answering a call light), and how we get that out there so that it is readily available for everybody, and I think that s what stops you from answering lights sometimes. You say, I don t know what to do with this person anyway. Let their nurse take care of them.

Generic signage If we have 35 patients on the floor and shy ten they are all on fall precautions. It s like everybody falls into that category.

6 6 The Fall TIPS Toolkit Requirements

7 The Fall TIPS Toolkit: Fall Risk Assessment/Tailored Plan Fall risk assessment Tailored plan based on patient s determinants of risk 7

8 8 The Fall TIPS Toolkit: Bed Poster

9 9 The Fall TIPS Toolkit: Patient Education Handout

10 10 The Fall TIPS Toolkit: Plan of Care

11 Research Questions Did patients on units using the Fall TIPS toolkit have 1. Fewer falls 2. Fewer falls with injury (secondary outcome) than patients on units without the Fall TIPS toolkit? 11

12 Results Control Units Intervention Units Rate Difference P Value Baseline Fall rate/ 1000 patient days All Patients No. pts with falls/ total no. patients 87/ / *Adjusted Fall rate/ 1000 patient days Observed no. falls with injury Patients aged <65 No. pts with falls/ total no. patients 36/ / *Adjusted Fall rate/ 1000 patient days Observed no. falls with injury Patients aged >/=65 No. pts with falls/ total no. patients 51/ / *Adjusted Fall rate/ 1000 patient days Observed no. falls with injury *Adjusted for site, sex, race

pts with falls/ total no. patients 36/2595 33/2405.72 *Adjusted Fall rate/ 1000 patient days 3.76 3.72.04.97 Observed no. falls with injury 3 7.

13 To our knowledge, this is the first clinical trial to provide evidence that a specific HIT intervention reduced falls in acute care short-stay hospitals There were fewer falls in intervention units than in control units Patients aged 65 or older benefited most from the Fall TIPS toolkit No significant effect was noted in fall related injuries 13

falls in intervention units than in control units Patients aged 65 or older benefited

14 What we learned Falls are prevented when key stakeholders have easy access to patients specific risks for falling and current care plan with tailored interventions to prevent falling Innovations should be thoughtfully introduced A picture is worth a thousand words 14

care plan with tailored interventions to prevent falling

15 Conclusion: What should acute care hospitals do to prevent patients from falling? Conduct accurate fall risk assessments. Generate care plans using HIT linking assessments to evidence based interventions to prevent patients from falling. Have the fall prevention plan immediately available pictorially and in plain text for all key stakeholders (patients, family, staff).

Generate care plans using HIT linking assessments to evidence based interventions to prevent

16 Fall TIPS (Tailoring Interventions for Patient Safety) Research Team/Funding Support Investigators Patricia C. Dykes, DNSc, RN Diane Carroll, PhD, RN Ann Hurley, DNSc, RN Stuart Lipsitz, ScD Blackford Middleton, MD, MPH, MSc Research/HIT Team Angela Benoit, BComm Frank Chang, MSE Jan Horsky PhD Seth Meltzer Lana Tsurikova, MSc, MA Luba Zuyev, MA

Dykes, DNSc, RN Diane Carroll, PhD, RN Ann Hurley, DNSc, RN Stuart Lipsitz, ScD

17 17 Questions?

Adapting the Fall Prevention Tool Kit (FPTK) for use in NHS Acute Hospital settings in England: Patient and Public Involvement evaluation

Adapting the Fall Prevention Tool Kit (FPTK) for use in NHS Acute Hospital settings in England: Patient and Public Involvement evaluation Authors: Dawn Dowding PhD RN Professor of Applied Health Research,